MANAGED CARE REFORM: Republicans Release Their Own Package
Assembly Republicans yesterday unveiled a "modest" package of managed care reforms that "follow the outline" recommended by Gov. Pete Wilson last month, the San Diego Union-Tribune reports. According to Assemblyman Bernie Richter (R-Chico), the reforms are designed to ensure that consumers "receive the services contained in their health plans." Richter said, "There's this notion that people have been inappropriately denied coverages that they've paid for" (Ainsworth, 2/20).
The Republican set of bills includes a requirement that consumers be offered a "second opinion and outside reviews when care is denied," the AP/Bakersfield Californian reports. In addition, the package would require "written policies for approving or denying care, provide a second opinion in certain surgery or other serious cases and provide continuity of care for serious cases." The Republican plan would also create a Department of Health Care Oversight to take over HMO oversight duties from the Department of Corporations, "and would provide tax breaks for health insurance costs and preventive care for farmworkers." However, the bills differ from Democratic proposals by not mandating coverage for specific conditions or treatments. The Democratic plan, announced two weeks ago, "includes requirements that plans cover minimum stays for mastectomies, second opinions, mental health and contraceptives" (2/20).
The AP/Contra Costa Times reports that Democrat and Republican reform packages have "some common threads that could produce agreement" on managed care reform this year. Both allow access to second opinions in certain cases and would mandate "external reviews of decisions to deny coverage." Beth Capell of Health Access said, "Republicans and Democrats agree something needs to happen. Californians are paying more and getting less. That's what's driving this anger. That's what legislators of both parties and the governor are hearing." However, Jamie Court of Consumers for Quality Care criticized the Republican package, "saying the bills won't protect HMO patients unless they make HMO directors legally liable for their decision" (Kerr, 2/20). The AP/Bakersfield Californian reports that in addition to the pending HMO reform legislation, "Consumers for Quality Care and Assemblyman Martin Gallegos (D-El Monte), are attempting to put on the November ballot an initiative that would make HMOs liable for quality of care violations and create a commission to oversee managed care plans." The AP/Bakersfield Californian also reports that the California Consumer Health Care Council of Oakland got the go-ahead yesterday to begin collecting signatures for a proposed initiative on the November ballot that "would prohibit insurers from either punishing doctors or other health providers for undertaking expensive procedures or rewarding them for denying expensive care." The group needs 433,269 signatures by April 17 in order to qualify (2/20).